Acost control policy that is in effect at your organization

Full Answer Section

• Organizational Level: Non-compliance with the policy can lead to increased healthcare costs, reduced profitability, and potential penalties from payers.
• Unit Level: Departments may experience budget overruns and difficulties in managing their operating expenses.
• Individual Level: Providers may face disciplinary action for prescribing non-authorized medications.

Impact on Fiscal Aspects:

• Cost Control: The policy acts as a cost control measure by limiting the use of expensive medications, reducing drug expenditures, and improving medication adherence.
• Financial Stability: Adherence to the policy can contribute to the financial stability of the organization by preventing unnecessary costs and ensuring that resources are allocated effectively.

Impact on Quality of Patient Care:

• Efficiency: The policy can improve efficiency by streamlining the medication approval process and reducing administrative burden on providers.

1. Breaking the Bottleneck: Streamlining Prior Authorizations and Unlocking Patient Access to Specialty Medications | Fierce Pharma

• Patient Outcomes: While the policy may have some unintended consequences, such as delays in patient access to medications, it can ultimately improve patient outcomes by ensuring that medications are prescribed appropriately.

Goals:

The primary goals of this policy are to:

• Reduce healthcare costs
• Improve medication adherence
• Ensure appropriate use of specialty medications
• Maintain high-quality patient care

Overall, the prior authorization policy for specialty medications has been effective in achieving its objectives. However, it is important to monitor the policy's impact and make adjustments as needed to address any unintended consequences or challenges.

Sample Solution

Cost Control Policy: Prior Authorization for Specialty Medications

Organization: A large, multi-hospital health system in the United States

Policy Implementation:

• Date: Implemented in 2015
• Scope: System-wide policy, affecting all departments and facilities within the organization

Policy Address:

This policy requires prior authorization for certain specialty medications, particularly those with high costs or limited clinical evidence. The goal is to ensure that these medications are prescribed appropriately and only when necessary.